New technologies for nephron-sparing surgery in upper urinary tract cancers
Andrea Gallioli1, Giuseppe Basile, Angelo Territo
1Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
Current Opinion in Urology
|August 18, 2023
Summary
Technological advancements in lasers and chemotherapy delivery enhance nephron-sparing surgery (NSS) for upper tract urothelial carcinoma (UTUC). These innovations aim to improve cancer detection and reduce recurrence after NSS.
Area of Science:
- Urology
- Oncology
- Surgical Technology
Background:
- Nephron-sparing surgery (NSS) is the standard for low-risk upper tract urothelial carcinoma (UTUC).
- Optimizing diagnostic tools and topical chemotherapy is key for better NSS outcomes.
- Technological progress is vital for advancing conservative UTUC management.
Purpose of the Study:
- To review recent technological advancements in the diagnosis and treatment of UTUC.
- To explore innovations impacting NSS for UTUC.
- To summarize evidence on new instruments and chemotherapy regimens for UTUC.
Main Methods:
- Review of recent literature on technological advances in UTUC diagnosis and treatment.
- Analysis of novel diagnostic tools, lasers, and chemotherapy delivery systems.
- Evaluation of emerging technologies for NSS in UTUC.
Main Results:
- Photodynamic ureteroscopy shows promise for improved cancer detection, especially for carcinoma in situ.
- Various lasers (Ho:YAG, Tm:YAG, Thulium Fiber Laser) are available for UTUC ablation, each with unique properties.
- Gel-based chemotherapy delivery systems are effective, while drug-eluting stents are still under development.
Conclusions:
- Technological innovations are optimizing NSS for UTUC, enhancing diagnosis and treatment.
- Further refinements in photodynamic ureteroscopy and laser technologies are needed.
- Novel chemotherapy delivery systems show potential for reducing recurrence and progression after NSS.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
10
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
10
01:26Kidney Transplant II: Surgical Procedure
36
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
36
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
55
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
55